busy day at the VA

I'm currently working full time as a plain old neurologist, not informaticist, at the Salt Lake VA, overseeing the inpatient and consult services, as well as fielding ER calls and clinic patients. The last couple days have been busier than usual. Without going into too much detail, here are some observations:

- When we admit a patient, whether for stroke or MS or whatever, it seems we spend almost as much time, energy and effort preventing complications of hospitalization as we do treating the main problem. And this is, unfortunately, necessary. Complications are what drives up costs and make for poor outcomes. I dread and loathe complications.

- There is an epidemic of sleep apnea going on. Sometimes it seems like half our patients have it, and the other half just haven't been diagnosed yet. Of those that have it, I would estimate 90% or more don't treat it because they can't stand the mask. I know it's not easy, but I am tired of hearing "Fix my headaches" and "I can't stand the mask" in the same breath. Maybe your headaches are trying to tell you something: your brain wants more oxygen at night!


- Since I graduated from residency 7 years ago, aside from the sleep apnea prevalence, not much else has changed. Everyone has hypertension, obesity, hyperlipidemia, diabetes, COPD and depression, but what they most want to talk about is prostatic hypertrophy and can they get some of that Viagra? ;-)

- Really, despite the above, I like being at the VA and treating veterans. I feel like we do a lot of good things here. It is hard, though, to see people who are close to the end of their lives and to see and hear their suffering, and that of their families, close up. Especially on neurology, we see a fair number of people who just don't know what's happening to them and can't comprehend where they are, who is in their room, why they can't get out of bed and why they can't go home. :-( Sometimes there's just not a lot we can do.

And on that cheery note, it's time to go!